'The Dean'

Bonnie Price, the longest tenured forensic nurse in the region, marries the medical and legal worlds with her expertise in evidence collection, empowering her students and sexual assault survivors with knowledge

by

“What’s Locard’s Principle?” asks Bonnie Price in her slightly Southern drawl. “Ever heard of it?”

She pauses, waiting for one of the two dozen Henrico County police recruits in the room to offer a response. Wearing badge-less blue uniforms and shiny black shoes, they filed in and sat down in unison an hour earlier for a crash course on how to respond to calls involving victims of sexual assault. She can’t remember how many times she’s delivered the presentation, only that the recruits look younger and younger each time she does.

Price paces around the room in a purple blazer over a floral blouse, a hospital ID badge pinned below her right shoulder.

“When someone enters a crime scene, they’re going to leave something of themselves and they’re going to take something with them,” she tells them. “That’s the principle forensics is based on. That’s why I do what I do.”

Price, 49, is the director of the Bon Secours Richmond Health System’s forensic nursing program based at St. Mary’s Hospital. She and a team of nine other specially trained nurses work with law and social service agencies in 23 communities across Central Virginia to gather physical evidence from sexual assault, child sexual abuse and domestic violence victims that can be cited in criminal trials. Forensic nurses bridge the medical and legal fields.

With 22 years of experience, Price is the longest tenured forensic nurse in the region and possibly the state. It’s nothing short of extraordinary, considering the average tenure for a nurse in the Bon Secours program is less than two years. Estimates place the average turnover nationwide at four years. The emotional toll of working with traumatized patients and associated pressures — one piece of evidence missed or improperly documented could be the difference between an acquittal and a conviction — leads to burnout, Price says.   

“I look for nurses who are able to compartmentalize what they do; that’s the only reason I’ve survived, because I can, at least in most cases, leave work at work. If not, this work is toxic, and I would not survive.”

Price hasn’t just survived; she has thrived. In 2014, she received the International Association of Forensic Nurses’ Virginia A. Lynch Pioneer award, the profession’s highest honor, for her contributions to the field.

“She’s devoted herself in ways that people don’t always see,” says Lisa Schiermeier-Wood, a forensic scientist supervisor at the Virginia Division of Consolidated Laboratory Services. She has worked with Price for the last two decades.

Aside from the thousands of patients she’s treated in her career, Price has conducted dozens of training sessions and workshops on the East Coast for nurses interested in the field or furthering their education. A conservative estimate places the number of participants somewhere between 750 and 1,000, she says.

“The job is her life,” says Sarah Jennings, a forensic nurse who has worked with Price at St. Mary’s since 2006. “It’s more than just a job to her. It’s really her passion.”

Victimized Twice

The youngest of three sisters, Price was raised by a stay-at-home mother and a father who taught welding and mechanics courses at the Richmond Adult Technical Center. Growing up, she says she never wanted to be a nurse. Instead, she eyed a career in law enforcement, but couldn’t meet the requirement of uncorrected 20/20 vision.

In the Price household, higher education wasn’t a given, or even an expectation. Neither of her parents or older siblings went to college. Had a friend not invited her to attend an LPN program at the Richmond Technical Center, Price may not have done so, either.

After receiving her certification, she took a job on the medical surgical floor of a small hospital in Tappahannock, where a small staff and a bad car accident introduced her to the adrenaline and excitement of the emergency department.

An opening at the old Richmond Memorial hospital eventually brought her back to Central Virginia. St. Mary’s hired her in 1987 as an emergency room nurse. There, she began to notice how poorly victims of sexual assault, domestic violence and child abuse were treated.

“In the early ’90s, victims of sexual assault would tell you that coming to the hospital and reporting to the police was much worse than the sexual assault was. Once they got here, what we did to them was way worse,” Price recalls.

At the time, a lack of training and research left hospitals and medical professionals ill-prepared to treat victims of sex crimes.

Accompanied by a uniform police officer, victims would sit in ER waiting rooms for hours, unable to shower or go to the bathroom (potential evidence could be lost), until a nurse or doctor with “no training whatsoever,” Price says, could conduct an exam.

Once under way, an exam consisted of a nurse or doctor reading the directions written on an envelope, swabbing where it said to swab, and packaging whatever evidence was found in what’s known as a physical evidence recovery kit, or PERK. No photos were taken to document injuries discovered.

Back then, the kits, too, were substandard. With no room for air circulation, fluid swabs in glass tubes would mold if not rushed to the laboratory or refrigerated at police stations with limited storage space, says Schiermeier-Wood. Precious evidence would be lost, and with it, a victim’s already long-shot chance at justice in the courtroom.

Throughout the ordeal, police and hospital employees would question victims repeatedly about their assault with no consideration given to how the questions would make the victim feel: You mean you were drinking alone at the bar before it happened? There were people nearby when it was happening; why didn’t you scream? It has been three days; why didn’t you report it sooner?

“I can tell you from talking to hundreds and hundreds of victims, it’s not that the rape wasn’t bad. It was that they were re-victimized at the hospital,” says Shelly Shuman-Johnson, director of victim and witness services for the Henrico County Commonwealth’s Attorney office.

In November 1993, Price was one of three nurses who launched the Bon Secours sexual assault nurse examiner (SANE) program, a precursor to modern forensic nursing programs, and the first of its kind in Central Virginia. At the time, there were fewer than 100 SANE programs at hospitals across the country.

On her lunch break from the ER one day, she and two colleagues saw a brochure advertising a weeklong class at Inova hospital in Fairfax for nurses interested in learning how to conduct sexual assault exams. At the time, Inova was the only hospital in the state with trained sexual assault nurse examiners.  

“When she told me she was interested in [taking the class], I think I said something like ‘Anything would be better than what we’ve got in the region now,’ ” says Lt. Jim Price, Bonnie’s husband and an officer in the Henrico police department for 42 years.

Price and her two colleagues took the initiative to attend the course and returned to Richmond. That same night, Price received a call from the ER: A patient who was sexually assaulted had arrived; could she come administer the exam? She drove in and treated them. Was she prepared?

“Compared to now? No.”

Over the years, Price has furthered her education. She finished her bachelor’s in nursing at Virginia Commonwealth University. As a full-time forensic nurse on-call 24 hours a day, seven days a week, she earned her master’s degree in forensics from Duquesne University, and finally her doctorate of nursing practice.

She’s not shy about encouraging her co-workers to return to the classroom to learn best practices and advance their careers. Her prodding has earned her the endearing nickname “dean” among the nurses with whom she works. Some, too, call her “mother.”

“To see her nurses grow, go back to school and make a difference, that’s what really drives her,” Sarah Jennings says.  

Body of Evidence

In 2014, Bon Secours nurse examiners treated about 1,900 victims of sexual assault, child abuse, elder abuse and domestic violence.

Instead of sitting in a packed waiting room, victims go to the forensic nursing program’s private office on the third floor of Medical Office Building North. There, a forensic nurse is always on duty, an improvement from the on-call system the hospital used to employ, made possible by more resources devoted to staffing. It is the only hospital system in the region that has someone on site to treat victims around the clock.

No two patients or exams are the same, Price says. Generally, forensic exams can last between two and six hours. First, the nurse will ask the victim about their history and the incident. The exchange is pivotal. A patient’s answers can inform where the nurse will look for evidence. For example, if a nurse does not think to ask the patient if they scratched their attacker, the nurse may not look for evidence under the fingernails, and it won’t be documented.

A head-to-toe physical examination and a gynecological assessment for injuries or potential evidence follow. Ultraviolet light can be used to determine where potential DNA, in the form of semen, blood or saliva, is left.  If the light detects a reaction, nurses swab the area to obtain a sample, bag it individually and document where on the patient it was found. If potential evidence is found, a patient’s clothes may be taken as evidence, as well.

Using a digital camera, nurses photograph cuts, bruises and bite marks readily visible, though these markings aren’t typical of most sexual assaults, four out of five of which are carried out by a person the victim knows with no physical struggle. For genital injuries that may be less apparent, nurses use what’s called a colposcope, which allows them to photograph vaginal tearing or other injuries, or, if a patient says the assault happened weeks ago, where tissue healing may have occurred.

Lastly, nurses make referrals for follow-up care and provide preventative medicine for STDs and pregnancy.

All of the evidence and documentation is placed in the PERK kit, a standardized container distributed by the state department of forensic science that at first glance could be mistaken for a shoebox. After sealing the box, the nurse hands it over to law enforcement, which is responsible for sending it to the state lab for processing. Last year, Bon Secours conducted about 150 PERK exams.

Patients can choose to file a report with law enforcement or request a blind kit, meaning they will undergo the exam but not file a report with police. The blind-kit option allows evidence recovered in the exam to be held for 120 days by the Virginia Department of Consolidated Laboratory Services. A patient can elect to file a report in that time by contacting the police department in the jurisdiction where the crime occurred. If not, the kit will be destroyed.  Some local police departments will store kits for as long as a year, Price says, but aren’t able to use the evidence in any investigation unless the patient opts to file a report.

The federal government expanded the Violence Against Women Act in 2005, mandating hospitals to provide victims of violence a forensic examination free of charge, even if the patient doesn’t want to pursue criminal charges against the perpetrator.

At the state level, the Criminal Injuries Compensation Fund provides hospitals with a refund for each PERK examination they provide. The refund is $1,200, a fraction of the cost. The hospital system absorbs the difference.

Upon arrival, some patients have a negative preconception of how police will handle their case, which prevents them from filing the report, Price says.  Young victims are worried their parents will find out. Others don’t want to press charges against known parties who carried out the assault, either out of fear or denial. More often than not, though, patients are willing to at least speak with police by the end of the examination.

Fatima Smith, coordinator for the Regional Hospital Accompaniment Response Team, has sat in on examinations Price has conducted as a volunteer advocate. The organization pairs survivors of sexual assault with volunteers who can accompany them during the forensic exam, if they choose. Price’s “survivor-centered” approach puts her patients at ease, Smith says.  

“Bonnie knows that while she may be a medical expert, she knows [the patient] is the expert on their situation, and I think that resonates with survivors,” Smith says. “You’re in the hospital because somebody exercised power and control over you. The last thing you want is a doctor or nurse telling you what to do.”

The patient-centric approach is the biggest difference between the field now and 20 years ago, Price says.

“Our goal in 2015 is for them to say, while the hospital visit isn’t great I feel empowered by what my choices are, I was provided with counseling and the necessary medication. There were people who understood how to take care of my special needs,” Price says.

Nurse examiners can be subpoenaed to testify in court. Plea agreements limit the number of times testimony is actually delivered, Price says, but on average, she has testified between five and 10 times a year.

In evidence collection and testimony, Bon Secours nurses are trained to be objective. In court they speak as experts, not victim advocates.

Legislative Gaps

April is national Sexual Assault Awareness Month. More than ever before, sexual assault has become a national talking point. Most notably, last November’s discredited Rolling Stone report about a University of Virginia student who was allegedly gang-raped at a frat house galvanized the national conversation. Addressing reporting issues on college campuses became a priority for lawmakers.

One thing seems clear: There’s a need for improvement in the justice system in dealing with victims of sexual assault.

Never one to pass the buck, Price believes it starts with training more and better forensic nurses.

Through her involvement with the International Association of Forensic Nurses, Price is editing the online manual that will serve as a guide for nurses across the nation who are new to the field. If all goes according to plan, the work will be published online in October 2015.

“Bonnie has been instrumental, and I don’t know if that word really captures her significance, in the development of forensic nursing’s core curriculum,” says Carey Goryl, the organization’s CEO.

In the next 10 years, Price says, she’d like to see every major hospital in the country have a  forensic nurse examiner on duty 24/7 to treat patients. With no regulation, it’s a hospital’s decision whether to fund a position or program, and some systems view forensic programs as luxuries or unnecessary costs. Today, only 700 forensic nursing programs exist nationwide.

In Virginia, state law detailing who can conduct a PERK examination applies only to patients who are unconscious or mentally impaired. No federal law regulates evidence collection for civilians who are sexual assault survivors, either. Depending on where they go for treatment, a survivor might get Bonnie Price, or they might get someone who has never conducted a forensic exam.  

In 2013, the Virginia General Assembly passed a law stating that any “licensed physician, physician assistant, nurse practitioner, or registered nurse” could perform a PERK exam on incapacitated victims. Price says the law doesn’t go far enough, as certified nurse examiners have special training in evidence collection that even doctors do not have. Price and others in the field advocated for a more stringent law about a decade back, but made little progress with legislators, she says.

It’s not that such laws are too complicated to write. Both the military and prison system have sexual assault evidence collection protocols set by federal legislation, Price points out.

Leaving Behind a Legacy

When Price told the class of Henrico police recruits about Locard’s Exchange Principle, she was paraphrasing. The basis of forensics can be simplified even further: Every contact leaves a trace.

Driving back from the training session to St. Mary’s, where she plans to check in on her nurses before heading home for the day, Price ponders for a moment before answering whether certain patients or cases have stuck with her through the years.

“You may not remember a patient’s name, but you’ll remember where she was when it happened, or what room they were in, or whether the rapist used a weapon during the assault.”

She is reluctant to say more, or whether the victims she has treated have taken a toll on her personally. Over the years, as her responsibilities have become more administrative and she hasn’t worked with as many patients, she says compartmentalizing her work has become easier. She still reviews each case, but hears fewer accounts directly.

In her downtime, Price visits antique stores, plays with her two dachshunds or takes trips to her beach house with her husband. What’s happening at the office is never out of mind, though, she admits. And retirement is out of the question. Not for another 10 or 15 years.

Pressed on another occasion, she reflects, “I’ve had colleagues who have said they don’t want to hear any more stories. They can’t do it anymore. I haven’t [gotten there] yet. To answer whether I will, I don’t know.”